RESEARCH
Comparing the effect of two educational
interventions on mothers’ awareness, attitude, and self-efficacy regarding sexual health care of educable intellectually disabled adolescent girls: a cluster randomized control trial
Shadi Goli1, Mahnaz Noroozi2* and Mehrdad Salehi3
Abstract
Background: Sexual problems of intellectually disabled adolescents are associated with their inability to under- stand sexuality. Given the important role of parents in forming the attitude of their adolescents towards sexuality, the present study aimed to compare the effect of two educational interventions on mothers’ awareness, attitude and self-efficacy regarding sexual health care of intellectually disabled adolescent girls.
Materials and methods: This cluster randomized control trial was conducted in six intellectually disabled adolescent education centers in Isfahan, Iran in 2018. The centers were randomly assigned to intervention groups (group training and training through booklet) and control group. Mothers of educable intellectually disabled adolescent girls (n = 81) were entered into the three groups using convenience sampling and their awareness, attitude and self-efficacy regarding sexual health care of adolescent girls were assessed using questionnaires before and after the educational intervention. Data were analyzed using descriptive and inferential statistical methods.
Results: The mean score of mothers’ awareness, attitude and self-efficacy in each of the “group training”, “training through booklet group” and “control group” was significantly different after the intervention compared to before the intervention (p < 0.05). The mean score of mothers’ awareness and self-efficacy after the intervention in the “group training” was higher than the “control group” and “training through booklet group” (p < 0.001). The mean score of mothers’ awareness and self-efficacy after the intervention in the “training through booklet group” was higher than in “control group” (p = 0.005, p = 0.02). Also, after the intervention, the mean score of mothers’ attitude in the “group training” was higher than the “control group” and the “training through booklet group” (p < 0.001), but there was no significant statistical difference between the mean score of mothers’ attitude in “control group” and “training through booklet group” (p > 0.05).
Conclusion: Implementation of the group training intervention for mothers of intellectually disabled adolescent girls in comparison with training through booklet was associated with a greater increase in their awareness, attitude and
© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Open Access
*Correspondence: [email protected]
2 Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran Full list of author information is available at the end of the article
Plain English summary
Intellectual disability refers to concomitant impairment in adaptive behavior that manifest during developmental years and at less than 18 years of age. Training parents plays an important role in helping them in the care of their adolescent’s sexual health. The purpose of this study was to compare the effect of two educational interven- tions on mothers’ awareness, attitude and self-efficacy about the sexual health care of intellectually disabled adolescent girls. This study was conducted in six intellec- tually disabled adolescent education centers in Isfahan, Iran in 2018. Mothers of educable intellectually disa- bled adolescent girls were entered into the three groups (group training, training through booklet and control group) and their awareness, attitude and self-efficacy regarding sexual health care of adolescent girls were assessed using questionnaires before and after the edu- cational intervention. The results showed that implemen- tation of the group training in comparison with training through booklet was associated with a greater increase in mothers’ awareness, attitude and self-efficacy about the sexual health care of intellectually disabled adolescent girls. Therefore, group training is suggested as a suitable way to educate mothers about sexual health care of intel- lectually disabled adolescent girls.
Background
Intellectual disability refers to concomitant impairment in adaptive behavior that manifest during developmen- tal years and at less than 18 years of age [1]. Causal factors in the creation of intellectual disability include genetic disorders, prenatal exposure to infections and toxins, perinatal trauma, acquired disorders and socio- cultural factors. Approximately 85% of intellectually disabled (ID) people fall into the mild (educable) cat- egory [2]. These individuals with intelligence quotient (IQ) range from 50 to 55 to 70 advances up to sixth grade elementary school in education and with limited social support; they can be guided towards social com- pliance and acquisition of independence [3]. Adoles- cent girls with intellectual disability do not learn how to control their sexual desires and express it in accord- ance with human laws and in a societal manner [4,5].
For this reason, they exhibit inappropriate behaviors such as masturbation and exhibitionism in public can
lead to their vulnerability to sexual abuse and harass- ment and consequences like unwanted pregnancies, sexually transmitted infections (STIs) and HIV/AIDS [6,7]. Numerous studies have shown that id adolescent girls are abused by family members, caregivers, close relatives, and other community members [8–12].
Since studies suggested that sexual problems of id ado- lescents are rooted in their inability to understand sexu- ality, unawareness and inability of parents, caregivers and teachers multidimensional interventions must be consid- ered [13–15]. Parents play an important role in forming the attitude of id adolescents toward puberty and sexual- ity [[[[16]]]]. Yıldız and Cavkaytar in a study showed that sexual training program can cause positive changes in mothers’ attitude towards sexual education and improve their understanding of social support [17]. The results of other studies showed that training parents with id chil- dren plays an essential role in enhancing their awareness and self-efficacy, changing their attitudes and behaviors about sexual education and talking to their child about sexuality [18,19]. Regarding the difference of socio-cul- tural and religious context of Iran with other countries and the taboo of talking about sexual issues [20,21], lim- ited studies have been done in this area [4–6,20]. There- fore, it is necessary to perform studies to determine the effect of training parents about sexual health care of id adolescent girls. Sexual health education programs should be tailored to gender, age, level of knowledge, and socio-cultural background. Given the possibility of providing training in different ways, choosing the right method has an important role in the success of the train- ing [22]. One of the training methods is group training.
Group training is a way of stimulating thinking that chal- lenges beliefs and attitudes and teaches individual skills.
In this way, if the learners are ready to participate in the discussion or the subject is understandable to them, training can gain an acceptable success [23]. Another method of training is through booklet which usually can be used when there is not sufficient number of train- ers [24]. Given the special role of mothers in caring for their adolescent girls, sexual health and regarding so far no study has been done to compare the effect of differ- ent training methods on mothers’ awareness, attitude and self-efficacy about sexual health care of id adolescent girls, so, the present study was conducted to compare the effect of two educational interventions on mothers’
self-efficacy regarding sexual health care of adolescent girls. Therefore, group training is suggested as a suitable way to educate mothers about sexual health care of intellectually disabled adolescent girls.
Trial registration IRCT, IRCT20160224026756N5. Registered 22 June 2018, https ://en.irct.ir/user/trial /31704 /view.
Keywords: Intellectual disability, Adolescent, Sexual health, Training, Awareness, Attitude, Self-efficacy
awareness, attitude and self-efficacy about the sexual health care of id adolescent girls.
Methods
CONSORT guidelines were adhered for reporting of this trial.
Study design
This study (as a part of expanded mixed methods study [25]) was a cluster randomized control trial with three groups (intervention 1, intervention 2 and control). The population of this study includes mothers of id adoles- cent girls who referred to six id adolescents’ training centers covered by Welfare Organization and Special Education Organization of Isfahan city, Isfahan province, Iran from June to August 2018. There were an appro- priate number of id adolescent girls and their mothers with the same socio-economic status who referred to these centers. Based on the confidence interval of 95%, a test power of 80% (using G-power software), d = 2.9 for awareness, d = 11.3 for attitude, d = 5 for self-efficacy and considering a sample loss rate of 10%, sample size of 27 was estimated for each group.
The inclusion and exclusion criteria
The inclusion criteria were mothers who had not previ- ously completed adolescent’s sexual health education or child sexual abuse prevention courses; mothers were not educated in the field of medicine, allied medical sciences, and psychology; and mothers who could read and write.
Exclusion criteria were reluctant to continue collaborat- ing in any stage of the study and lack of full participation in the training sessions held in the group training (failure to receive 50% of the intervention).
Procedures
In the present study, for preventing relationships and interactions between participants about the educational interventions, from six id adolescents’ training centers, two were randomly selected for “group training”, two for
“training through booklet” and two for “control group” by first author (SG). Samples were selected in each id ado- lescents’ training center using the convenience sampling.
In the centers, by examining 310 records of adolescent girls, their mothers’ were called and the purpose of the study was given to them and they were invited to partici- pate in the study. Ninety mothers refused to participate in the study. Then, since out of 139 mothers who referred to the six centers, 81 eligible mothers were enrolled and after obtaining written consent, they were entered in the study (Fig. 1). For the participants in “group train- ing” (n = 27), four training sessions of one-week inter- val was hold for each subgroup (four subgroups of 6–7
persons). In “group training”, the researcher provided the training content in three stages of introduction, pres- entation and conclusion. To avoid boring sessions, the presentation of the content was done by a lecture for 45–50 min according to the research objectives, and by discussing, question and answer, mothers were encour- aged to activity and their experiences was shared. The aim of this question and answer was to increase mothers’
awareness, change her attitude and enhance self-efficacy in the field of sexual health care of id adolescent girls.
During the “group training” sessions, educational items were expressed in a way that mothers consider the issue of their daughter’s sexual health care to be important and know themselves to be able to care for and protect their daughter’s sexual health. Mothers were also asked to provide examples to describe their successful experi- ences about taking care of their daughter’s sexual health and to discuss this with each other in this subject. Also, by encouraging and emphasizing their individual capa- bilities in taking care of their daughter’s sexual health, it was tried to increase their self-efficacy. At the end of the session, the main concepts were reviewed, the con- tents presented were linked together, summarized, and questions were answered. In the case of mothers who were assigned to the group of “training through book- let”, after delivering the booklet, they were reminded that they would be answered by telephone if they had a ques- tion. The contents of the booklet were the same as those taught in “group training” sessions. In formulating the training booklet, the training content was also presented in a way that mothers, consider the issue of their daugh- ter’s sexual health care to be important and know they are able to take care for and protect their adolescent’s sexual health. In other words, the training content of the booklet was designed to encourage mothers to apply, the tips contained in it to take care of their daughter’s sex- ual health in a practical and accessible way. Educational content included puberty, adolescence and its changes;
female genitalia; menstruation and common menstrual problems in id adolescent girls; common concerns of par- ents during adolescence period in their daughter; sexual desires and behaviors of id adolescent girls; purpose and necessity of sexual health education; appropriate oppor- tunities for teaching sexual health to the adolescent; use the correct names for different parts of the body; privacy, private and public parts of the body; private and pub- lic places; body rights and private conversations; duties of parents in preventing sexual harassment and abuse in adolescents; sexual harassment and abuse in cyber- space; the rules for using the Internet and cyberspace;
unwanted pregnancies and STIs; inappropriate sexual behaviors (masturbation, exhibitionism, etc.) in adoles- cents and how to control these behaviors. In the present
study, there was no intervention in the control group and participants only completed the questionnaires in two stages. In this regard, a training booklet was given to the participants in control group after the intervention.
Primary outcomes
The primary outcomes included mothers’ awareness, atti- tude and self-efficacy about the sexual health care of their id adolescent girls that were measured by the researcher- made questionnaires (awareness and attitude question- naires, as well as general self-efficacy questionnaire [23].
These questionnaires were completed by the participants at two stages (before the intervention and one month after the intervention) in id adolescents’ training cent- ers. The first part of the questionnaire included demo- graphic characteristics (age, occupation and education level; number of children; age, occupation and educa- tion level of spouse; and age and level of education of
id adolescent). The mothers’ awareness questionnaire consisted of 23 questions and the questions had three choices of “True, False and Don’t Know”. In assessing the score of awareness, one point was given to the person for each correct answer. Minimum awareness score was zero and maximum was 23. The mothers’ attitude ques- tionnaire consisted of 18 questions and was given one to five points based on a 5-point Likert scale with choices of
“strongly agree, agree, neutral, disagree and strongly dis- agree”. Minimum attitude score was one and maximum score was 90. Standard general self-efficacy questionnaire consisted of 10 four-point questions “not at all correct, hardly correct, almost correct, and completely correct”
and was scored on a four point Likert scale from one to four. The minimum self-efficacy score was one and the maximum was 40 [26]. Content validity method was used to determine the validity of the questionnaires of aware- ness and attitude assessment, and test–retest was used Fig. 1 Trial flowchart
to confirm their reliability. Questionnaires reliability was confirmed by Pearson’s correlation coefficient of 0.91.
Statistical analysis
Statistical analysis of the present study was conducted using SPSS software (version 23). The one-way ANOVA and Fisher’s exact test were used for assessing the consist- ency of the three groups in terms of socio-demographic characteristics. To compare mean score of mothers’
awareness, attitude and self-efficacy in each group paired t-test was used before and after the intervention. To com- pare the mean score of mothers’ awareness, attitude and self-efficacy between the three groups one-way ANOVA was used before and after the intervention. Also, Post hoc LSD test were used for comparison of means difference between two groups after the intervention. The signifi- cance level for statistical tests was considered less than 0.05 (P < 0.05).
Ethical considerations
This study was registered in the registry for clinical tri- als (IRCT20160224026756N5). The Ethics Commit- tee of Isfahan University of Medical Sciences approved the protocol of this study (code number: IR.MUI.
Rec.1395.3.281). Written informed consent, confidential- ity, anonymity, and the right of leaving the research at any desired time were preserved.
Results
The results showed that the mean age of mothers and their spouses, level of education and job of mothers and their spouses, mean number of their children, mean age and level of education of their id adolescent girl were not significantly different between the three groups (p > 0.05) (Table 1).
Primary outcomes
The results showed that the mean score of mothers’
awareness, attitude and self-efficacy in each of the “group training”, “training through booklet group” and “control group” after the intervention was significantly different from that before the intervention (p < 0.001) (Tables 2, 3, 4). The mean score of mothers’ awareness, attitude and self-efficacy before the intervention was not significantly different between the three groups (p > 0.05), but one month after the intervention, the mean score of moth- ers’ awareness, attitude and self-efficacy showed a sig- nificant statistical difference between the three groups (p < 0.001) (Table 5). In this regard, one month after the intervention, the mean score of mothers’ awareness, atti- tude and self-efficacy was significantly different in the
“group training” compared with the “training through booklet group” and “control group” (p < 0.001). Based
on the results, the mean score of mothers’ awareness and self-efficacy was significantly different in the “train- ing through booklet group” compared with the “control group” (p = 0.005, p = 0.02), but the mean score of moth- ers’ attitude was not significantly different in the “train- ing through booklet group” compared with the “control group” (p > 0.05) (Table 6).
Discussion
The present study aimed to compare the effect of two educational interventions on mothers’ awareness, atti- tude and self-efficacy regarding sexual health care of id adolescent girls. The results showed that the mean score of mothers’ awareness, attitude and self-efficacy after the intervention in each of "group training" and "train- ing through booklet group" was significantly higher than before the intervention. In this regard, the results of Kok and Akyuz,s study about the effect of group training on parent’s awareness and self-efficacy in managing id ado- lescent girls’ sexual development showed that parent’s awareness and self-efficacy was increased after training [27]. Also, a study showed that significant changes were made in parental attitudes after educational intervention through laptop and they gained the confidence and skills needed to provide their disabled child with sex educa- tion [18]. The results of the present study showed that the mean score of mothers’ awareness, attitude and self-effi- cacy in the "control group" was significantly higher than before the intervention. It seems that mothers’ exposure to sexual issues related with id adolescent girls (follow the completion of the questionnaires) has faced them with concerns and questions that they have tried to gain information through relatives, friends, and other sources during the study. The results of the present study showed that one month after the intervention, the mean score of mothers’ awareness, attitude and self-efficacy was higher in the “group training” than the “training through booklet group” and “control group “. Rashid and Hosseini Nazar- lou showed that group training was effective in enhancing parent’s awareness and feeling of competence regarding sexual education of their child [28]. Kardan et al. believed that the motivating role of the teacher in group training can provide the conditions for understanding new con- tent [29]. Shahraki Sanavi et al. in their study concluded that to change attitudes, group training is needed and individual and self-taught methods are not effective [30].
It seems that in the present study, due to the presence of the researcher in the “group training” and creating an opportunity for question, answer and discussing about id adolescent girls, sexual health, not only learning is done better, but also the researcher has been able to eliminate the mothers, wrong beliefs and create a positive attitude towards the issue of sexuality of id adolescent girls. Also,
in “group training”, due to the researcher’s effective role in encouraging mothers and emphasizing their individual abilities in taking care of their daughters’ sexual health,
their self-efficacy increased more than training through booklets. Babayanzad Ahari et al. concluded that par- ents required training to enhance their knowledge and Table 1 Comparison of socio-demographic characteristics of the participants between the three groups
Id intellectually disabled
* P < 0.05 was considered significant
Variable Group training
N (%) Training through booklet
N (%) Control group
N (%) p-value*
Age (years) 0.63
25–34 4 (15) 3 (11) 2 (8)
35–44 11 (40) 12 (44) 12 (45)
45–54 11 (41) 11 (41) 11 (40)
≥ 55 1 (4) 1 (4) 2 (7)
Spouse age (years) 0.74
35–44 4 (15) 3 (11) 2 (7)
45–54 11 (40) 13 (48) 10 (38)
≥ 55 12 (45) 11 (41) 15 (55)
Number of children 0.23
1 3 (11) 2 (7) 1 (4)
2 9 (34) 13 (48) 10 (37)
≥ 3 15 (55) 12 (45) 16 (59)
Educational level 0.17
Elementary 1 (4) 0 (0) 0 (0)
Intermediate 9 (34) 12 (44) 9 (33)
High school and diploma 13 (47) 9 (34) 14 (52)
Academic 4 (15) 6 (22) 4 (15)
Job 0.31
Employee 4 (15) 5 (19) 6 (22)
Worker 2 (7) 0 (0) 0 (0)
Housewife 20 (74) 17 (63) 16 (59)
Other 1 (4) 3 (18) 5 (19)
Spouse educational level 0.29
Elementary 2 (7) 1 (4) 1 (4)
Intermediate 10 (37) 8 (29) 11 (41)
High school and diploma 11 (41) 14 (52) 10 (37)
Academic 4 (15) 4 (15) 5 (18)
Spouse job 0.44
Unemployed 2 (7) 1 (4) 2 (7)
Worker 4 (15) 7 (26) 8 (30)
Employee 11 (41) 9 (33) 10 (37)
Self employee 6 (22) 9 (33) 4 (15)
Other 4 (15) 1 (4) 3 (11)
Age of id adolescent girl 0.23
11–15 10 (37) 14 (52) 12 (44.5)
16–20 17 (63) 13 (48) 15 (55.5)
Educational level of id adolescent girl 0.23
Elementary 8 (29) 3 (11) 9 (34)
Primary high school 4 (15) 18 (67) 14 (52)
Secondary high school 14 (52) 6 (22) 2 (7)
Diploma 1 (4) 0 (0) 2 (7)
Table 2 Comparison of the mean score of mothers’ awareness, attitude and self-efficacy before and one month after the intervention in the group training
Variable Before the intervention One month after the intervention Statistical test results
Mean SD Mean SD F p
Awareness 9.81 9.05 17.07 1.59 1.49 < 0.001
Attitude 58.81 12.72 82.11 4.51 1.69 < 0.001
Self-efficacy 22.92 5.01 33.03 4.09 0.81 < 0.001
Table 3 Comparison of the mean score of mothers’ awareness, attitude and self-efficacy before and one month after the intervention in the training through booklet
Variable Before the intervention One month after the intervention Statistical test results
Mean SD Mean SD F p
Awareness 12.18 3.41 15.14 2.08 − 9.92 < 0.001
Attitude 61.74 9.80 69.96 7.71 − 6.95 < 0.001
Self-efficacy 22.70 6.03 28.70 5.25 − 3.87 < 0.001
Table 4 Comparison of the mean score of mothers’ awareness, attitude and self-efficacy before and one month after the intervention in the control group
Variable Before the intervention One month after the intervention Statistical test results
Mean SD Mean SD F p
Awareness 11.44 3.76 13.25 2.62 − 6.67 < 0.001
Attitude 64.22 8.90 68.14 8.01 − 9.69 < 0.001
Self-efficacy 24.00 5.28 25.66 4.25 − 7.03 < 0.001
Table 5 Comparison of the mean score of mothers’ awareness, attitude and self-efficacy one month after the intervention between the three groups
Variable Group training Training through booklet Control Statistical test results
Mean SD Mean SD Mean SD F p
Awareness 17.07 1.59 15.14 2.08 13.25 2.62 21.37 < 0.001
Attitude 82.11 4.51 69.96 7.71 68.14 8.01 32.39 < 0.001
Self-efficacy 33.03 4.09 28.70 5.25 25.66 4.25 17.78 < 0.001
Table 6 Pairwise comparison of the mean score of mothers’ awareness, attitude and self-efficacy one month after the intervention
CI confidence interval
Variable Control Group and Group training Training through booklet & control
group Group training & Training
through booklet Mean difference (95% CI) p Mean difference
(95% CI) p Mean difference (95%
CI) p
Awareness 3.81 (2.5–6.2) < 0.001 1.88 (0.3–59.18) 0.005 1.92 (0.2–91.93) < 0.001
Attitude 13.96 (10.17–41.51) < 0.001 1.81 (2.6–48.11) 0.40 12.14 (8.15–69.60) < 0.001
Self-efficacy 7.37 (5.9–8.65) < 0.001 3.03 (0.5–42.64) 0.023 4.33 (1.6–75.90) < 0.001
skills to improve their communication with their adoles- cents about sexuality issues through culture-appropriate educational programs [31]. Furthermore, in a study, the major barriers about sexual health education for ado- lescent daughters identified by the mothers were their own insufficient knowledge about sexual issues, embar- rassment surrounding discussions of this issue with their daughters, fear of the arrogance and curiosity of girls, and a lack of skills for effective communication [32]. Thus, based on the results of present study, “group training”
can help mothers overcome barriers and empower them to take care of their daughter’s sexual health. In the pre- sent study, the content of booklet was designed in such a way that mothers while becoming aware of their id ado- lescent girl’s sexual health issues, know to be able to care for and protect their daughters’ sexual health. Therefore, mothers’ awareness and self-efficacy regarding sexual health care of id adolescent girls was increased in “train- ing through booklet group". But, similar to the results of other studies [33], it seems that “training through book- let”; one may not be able to positively affect mothers’
beliefs and attitudes.
Practical implications
Findings from the present study can be useful in design- ing and improving the educational methods available in the health system and ministry of education for educat- ing mothers with id adolescent girls. In this regard, by using the “group training”, mothers find a positive atti- tude towards the sexuality of the id adolescent girls and can be empowered to solve the sexual health problems of their daughters and to deal properly with unexpected events. Also, using educational booklets can increase mothers’ awareness and self-efficacy about caring for the sexual health of their id adolescent girls.
Strengths and limitations
One of the strengths of this study is the implementation of educational intervention on mothers’ awareness, attitude, and self-efficacy regarding sexual health care of educable id adolescent girls, for the first time. One of the limitations of this study is the sensitivity and taboo of sexual issues and the feeling of shame about addressing these issues that can influence information gathering. Mothers’ attitudes toward sexual problems of id adolescent girls were also affected by varying degrees of social, religious, moral, and legal norms that were out of control. In addition, mothers’ individual differences in learning and motivation were factors asso- ciated with the effect of education and it was not possible to control this variable. Mothers’ familial, social, and eco- nomic problems also affected how to answer the questions
which could not be controlled. Since the effect of clustering had not been considered while calculating sample size, this could have affected the results of the research.
Conclusion
The findings of this study showed that “group training”
compared to “training through booklet”, has a more posi- tive effect on mothers’ awareness, attitude, and self-efficacy in the care of sexual health of educable id adolescent girls and empowers them to manage sexual behaviors of their id adolescent girls and deal with unexpected events. There- fore, designing and applying “group training” is recom- mended in mothers’ educational programs about sexual health care of id adolescent girls.
Abbreviations
IQ: Intelligence quotient; ID: Intellectually disabled; STIs: Sexually transmit- ted infections; HIV: Human immunodeficiency virus; AIDS: Acquired immune deficiency syndrome.
Acknowledgements
We should thank the Vice-chancellor for Research of Isfahan University of Medical Sciences for their support.
Authors’ contributions
All the authors contributed to the conception and design of the study. SG drafted the first version of the manuscript. MN and MS revised the manuscript.
MN critically reviewed the manuscript for important intellectual content. All authors read and approved the final version.
Funding
Financial support by Isfahan University of Medical Sciences, Research proposal No: 395281. The funding agency played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
Availability of data and materials
The datasets generated and/or analysed during the current research are not publicly available as individual privacy could be compromised but are avail- able from the corresponding author on reasonable request.
Ethics approval and consent to participate
The Ethics Committee of the Isfahan University of Medical Sciences in Isfahan, Iran approved the protocol of this study (code number: IR.MUI.Rec.
1395.3.281). Written informed consent is taken from each participant.
Consent for publication Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1 Nursing and Midwifery Sciences Development Research Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran. 2 Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran. 3 Medical School, Isfahan University of Medi- cal Sciences, Isfahan, Iran.
Received: 5 December 2019 Accepted: 21 February 2021
•fast, convenient online submission
•
thorough peer review by experienced researchers in your field
• rapid publication on acceptance
• support for research data, including large and complex data types
•
gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year
•
At BMC, research is always in progress.
Learn more biomedcentral.com/submissions Ready to submit your research
Ready to submit your research ? Choose BMC and benefit from: ? Choose BMC and benefit from:
References
1. American Association on Intellectual Developmental Disabilities (AAIDD).
Definition of intellectual disabilities. 2013. http://aaidd .org/intel lectu al-disab ility /defin ition #.UjosL Nit-VM201 3. Accessed 27 May 2019.
2. Katalinić S, Šendula-Jengić V, Šendula-Pavelić M, Zudenigo S. Repro- ductive rights of mentally retarded persons. Psychiatr Danub.
2012;24(1):38–43.
3. Sadock B, Ruiz P. Kaplan & Sadock’s synopsis of psychiatry: behavioral sciences. Netherlands: Walters Kluwer; 2015.
4. Akrami L, Davudi M. Comparison of behavioral and sexual problems between intellectually disabled and normal adolescent boys during puberty in Yazd, Iran. Iran J Psychiatry Behav Sci. 2014;8(2):68–74.
5. Arfe-ee FS, Yazdakhasty A, Afshar S, Rahimi H, Normohammadi-Najaf AM.
Crises of maturity and sexual, behavioral and psychological problems related to it in girls with intellectual disability. IJARP. 2014;1(2):49–56.
6. Akrami L, Mirzamani M, Davarmanesh A. Comparison of sexual problems in intellectually disabled and normal adolescent girls in the puberty period. J Shaheed Sadoughi Univ Med Sci. 2011;19(1):24–34.
7. Eastgate G. Sex and intellectual disability: dealing with sexual health issues. Aust Fam Phys. 2011;40(4):188–91.
8. Wissink IB, Van Vugt E, Moonen X, Stams GJJ, Hendriks J. Sexual abuse involving children with an intellectual disability (ID): a narrative review.
Rese Dev Disabil. 2015;36:20–35.
9. Vadysinghe A, Dassanayaka P, Sivasubramanium M, Senasinghe D, Samaranayake A, Wickramasinghe W. A study on sexual violence inflicted on individuals with intellectual developmental disorder. Disabil Health J.
2017;10(3):451–4.
10. Walker-Hirsch L. The facts of life—and more: sexuality and intimacy for people with intellectual disabilities. USA: Springer; 2008.
11. Conod L, Servais L. Sexual life in subjects with intellectual disability. Salud Pública Mex. 2008;50:s230–8.
12. Murphy NA, Elias ER. Sexuality of children and adolescents with develop- mental disabilities. Pediatrics. 2006;118(1):398–403.
13. Büyükbayraktar ÇG, Er RK, Kesici Ş. Creating awareness of sexual abuse in children with special education needs: depending on the opinions of teachers of the mentally handicapped. J Educ Train Stud. 2017;6(1):151–8.
14. Winarni TI, Hardian H, Suharta S, Ediati A. Attitudes towards sexuality in males and females with intellectual disabilities: Indonesia setting. J Intel- lect Disabil-Diag Treat. 2018;6(2):43–8.
15. Saxe A, Flanagan T. Unprepared: an appeal for sex education training for support workers of adults with developmental disabilities. Sex Disabil.
2016;34(4):443–54.
16. O’Neill J, Lima S, Thomson Bowe K, Newall F. The experiences and needs of mothers supporting young adolescents with intellectual disabilities through puberty and emerging sexuality. Res Pract Intellect Develop Disabil. 2016;3(1):37–47.
17. Yıldız G, Cavkaytar A. Effectiveness of a sexual education program for mothers of young adults with intellectual disabilities on mothers’ atti- tudes toward sexual education and the perception of social support. Sex Disabil. 2016;35(1):3–19.
18. Clatos K, Asare M. Sexuality education intervention for parents of children with disabilities: a pilot training program. Am J Health Stud.
2016;31(3):151–62.
19. Chou YC, Lu ZyJ, Chen BW, Lin CJ. ‘Transformed rights’ sexual health programme evaluation for the parents and service workers of adults with an intellectual disability. J Intellect Disabil Res. 2019;63(9):1125–36.
20. Shariati M, Babazadeh R, Mousavi A, Mirzaii Najmabadi Kh. Iranian adolescent girls’ barriers in accessing sexual and reproductive health information and services: a qualitative study. J Fam Plann Reprod Health Care. 2014;40(4):270–5.
21. Mousavi A, Babazadeh R, Mirzaii Najmabadi Kh, Shariati M. Assessing Iranian adolescent girls’ needs for sexual and reproductive health infor- mation. J Adolesc Health. 2014;55(1):107–13.
22. Hodges BC, Videto DM. Assessment and planning in health programs.
USA: Jones & Bartlett Learning; 2011.
23. Saif A. Modern educational psychology: the psychology of learning and instruction. 7th ed. Tehran: Doran Pub; 2019.
24. Abbasi P, Mohammad-Alizadeh Charandabi S, Mirghafourvand M. Com- paring the effect of educational software and booklet on knowledge level regarding labor pain management: a randomized controlled clinical trial. IJWHR. 2017;5(3):218–23.
25. Golil S, Noroozi M, Salehi M. A comprehensive sexual health care program for educable intellectually disabled adolescent girls: protocol for a mixed methods study. Reprod Health. 2018;15:141.
26. Rajabi GR. Reliability and validity of general self-efficacy beliefs scales (GSE-10) comparing the psychology students of Shahid Chamran university and Azad university of Marvdasht. New Thoughts Educ.
2006;2(2):111–22.
27. Kok G, Akyuz A. Evaluation of effectiveness of parent health education about the sexual developments of adolescents with intellectual disabili- ties. Sex Disabil. 2015;33(2):157–74.
28. Rashid K, Hosseini NM. Investigating the effect of sex education on enhancing parents’ sexual knowledge and their sense of competence. J Instr Eval. 2017;10(37):143–62.
29. Kardan BE, Bakhshandeh H, Nikpajouh A, Elahi E, Haghjoo M. Comparison of the effect of education through lecture and multimedia methods on knowledge, attitude, and performance of cardiac care. Iran J Cardiovasc Nurs. 2016;4(4):6–13.
30. Shahraki Sanavi F, Ansari-moghaddam A, Navabi RS. Two teaching methods to encourage pregnant women for performing normal vaginal delivery. Iran J Med Educ. 2012;12(3):184–92.
31. Babayanzad Ahari Sh, Behboodi Moghadam Z, Azin A, Maasoumi R.
Concerns and educational needs of Iranian parents regarding the sexual health of their male adolescents: a qualitative study. Reprod Health.
2020;17(1):24.
32. Shams M, Parhizkar S, Mousavizadeh A, Majdpour M. Mothers’ views about sexual health education for their adolescent daughters: a qualita- tive study. Reprod Health. 2017;14(1):24.
33. Bahri N, Bagheri S, Erfani M, Rahmani R, Tolidehi H. The comparison of workshop-training and booklet-offering on knowledge, health beliefs and behavior of breastfeeding after delivery. Iran J Obstet Gynecol Infertil.
2013;15(32):14–22.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub- lished maps and institutional affiliations.